Provider Demographics
NPI:1770917502
Name:MCDONALD, DELORES JUSTINE (OTR/L, CHT)
Entity type:Individual
Prefix:
First Name:DELORES
Middle Name:JUSTINE
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:DELORES
Other - Middle Name:JUSTINE
Other - Last Name:OSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L, CHT
Mailing Address - Street 1:4200 DAHLBERG DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4841
Mailing Address - Country:US
Mailing Address - Phone:952-512-5600
Mailing Address - Fax:
Practice Address - Street 1:5601 96TH AVE N STE 100
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-4505
Practice Address - Country:US
Practice Address - Phone:763-786-9543
Practice Address - Fax:763-786-3320
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104396225XH1200X
CAOT18984225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1114965704OtherNPI
WA7106636Medicaid
AB19869Medicare PIN